SARRAH Weekly Newsletter "Connected" 16 December 2022

From the CEO's desk

A nicely-timed publication has hit my desk in the past 24 hours from UNSW Canberra's Public Service Research Group about unregistered NDIS providers and why people use them. Lead author Helen Dickinson, Professor of Public Service Research at UNSW Canberra, and her team, interviewed 30 NDIS recipients and plan nominees who purchased supports from unregistered providers, publishing the results yesterday. It's great to hear some of the issues discussed through the voice of the consumer.

SARRAH regularly hears from our rural members about the significant costs to become a registered NDIS provider, including examples where business owners have had to remortgage their house to cover the cost of registration. Is it any wonder, then, that some allied health professionals, especially those operating small practices with mixed clientele, opt not to register? In a rural setting, the success of your business will be built on the relationships you have with your community and your professional network, and ensuring the quality of your service is a pivotal part of your success. It is likely that NDIS clients will come to you because of the existing relationship they have with you, and not because you are a registered NDIS provider.

This is supported by the findings of the report. With regard to allied health services, NDIS clients understood that allied health professionals were regulated through their respective registration boards, and that NDIS registration was not a guarantee of a higher quality service. One example described a case in which a client purchased services from a specialist physiotherapist at a higher rate than that prescribed in the NDIS pricing guide because they had the specific skills required to manage their complex condition. In this instance, requiring the client to seek therapies exclusively from NDIS registered services would only constrain consumer choice and control, with no guarantee of better quality services.

In the rural and remote context, requiring allied health services to be registered NDIS providers will negatively impact access to services in an already underserviced area. I do not mean to suggest that registered NDIS providers operating in rural and remote settings are of any less quality than their non-registered colleagues, nor vice versa. However NDIS clients should have the discretion to choose their own service providers, and in the rural context this may be the register NDIS provider, the local practice owner or one with specialist skills located in a regional or metropolitan city - or even a combination of these if only the systemic structures were in place to support collaboration and peer networking (as exists, for example, for medical professionals through rural clinical training schools).

Allied health professionals frequently operate across a number of regulatory systems. It would be great to see some reduction in the red tape so that quality and safety mechanisms were common across these frameworks, with affordable compliance requirements. Maybe then we would see more clarity and consistency around differential pricing for allied health services, and less confusion for clients.

And as this is our last edition of Connected for 2022, I'd like to take this opportunity to thank all of our members and friends for your continued support of SARRAH. Given we do not receive peak body funding, your support and input to our work is vital if the voice of rural and remote allied health is to be heard by decision-makers. We've had a great year and continue to be invited to participate in stakeholder consultations at the highest levels - this would not be possible without your support. It is also a testament to the work of our Director Policy and Strategy Allan Groth, and I thank him for his tireless efforts throughout 2022 to ensure SARRAH's submissions are of the highest quality and get to the right people, and for making our newsletter such an informative and highly-regarded read.

May you all have a great holiday season, and I hope you have an opportunity to detach and recharge with loved ones. I look forward to working with you in 2023.

Travel Safe,

Cath

The STAY Project is exploring professional development and support strategies that will strengthen the allied health workforce in the Loddon Mallee region of Victoria. In this episode of Talking for Purpose, Sarah Gallagher from Bendigo Health describes the intitaive in more detail.

Do you have any themes/topics that you would like to hear us discuss? People you’d like us to interview? Please drop us an email to our mailbox at sarrah@sarrah.org.au

Listen to earlier episodes here

Congratulations to proud Eastern Arrernte man Ryley Park, currently studying a Bachelor of Speech Pathology, on being recognised as a future leader in Indigenous Health, at the recent National Indigenous Allied Health Awards.

The Future Leader in Indigenous Health is awarded to a current IAHA Full Member (Student) enrolled in an entry level allied health degree who demonstrate leadership capabilities, a commitment to their studies and leadership journey and are an inspirational role model for other Aboriginal and Torres Strait Islander peoples. Here Ryley is being presented his award by our own SARRAH CEO, Cath Maloney.

The Strengthening Medicare Taskforce is due to release its report – possibly before Christmas.

Minister Mark Butler certainly makes it clear that the focus will be on medical general practice. From an interview he had on Radio National (RN Breakfast) with Patricia Karvelas on 14 December 2022:

So we've got no higher priority in the health portfolio than rebuilding general practice, because if general practice continues to decline and we see the declines in the bulk-billing rates, that's going to reverberate right through the health system. Health Ministers at a state level tell me they're deeply concerned about this, because they know the impact it's having on their on their hospital system. People are turning up to the emergency department who could quite adequately be cared for in the community, but they can't find a GP to see. So we will have more to say. As I said in the election campaign, we wanted to work with the sector to find the best way to invest that money. It's been a terrific process, I've chaired it, so I’ve been involved directly in those discussions with the College, the AMA, nursing groups and others. We're close to delivering our report and we’ll action that report in the Budget next year.

Few would argue the shift to primary health care has such wide support now that we may actually see the initial steps taken during in the Government’s Election commitments carry through to something approaching a structural shift. The question remains, however, whether allied health services will be heard, seen or treated as anything more than an adjunct to medical general practice and becomes something more than ”other”.

Some interesting and bi-lateral, joint activity in NSW – Commonwealth (Labor) and State (Coalition) regional health Ministers working together..
Commonwealth Minister Emma McBride and NSW Minister Bronnie Taylor were part of a joint Regional Health Forum held in Tamworth. Both are Ministers for regional health and for mental health in their respective jurisdictions. They engaged , together, with local health professionals and issued a communique. This may be a very positive sign of the collaborative approach we’ve increasingly heard about from National Cabinet and Health Ministers, and is a critically important and welcome development if so. We’ve heard, unsurprisingly that the meeting was strongly medical focussed, but at least one local allied health service provided took part and contributed. Positive, small steps.

Last week we flagged the release of the Grattan report - A new Medicare: strengthening general practice. There’s a useful summary of the recommendations by hospitalhealth.com.au.

And John Menadue came out arguing for real health reform - Medicare reform must not just be about more money to do the same things the same way.
Who’s John Menadue? He is presently Founder and Editor in Chief of an online newsletter called Pearls and Irritations. He has considerable insight to the nature of government and reform, as he was formerly Secretary of the Department of Prime Minister and Cabinet.

The AIHW has released four interesting updates:
The AIHW Burden of Disease Report – which showed for the first time in two decades there has been an increase in ill health experienced by Australians. The Study measures the years of healthy life lost by Australians by converting the impact of diseases and injuries to disability-adjusted life years (DALY), which include both the impact of living with poor health (the non-fatal burden of disease) and dying prematurely (fatal burden).

In response, the AMA were quick to come out with a response calling for more health funding, to go to GPs but also to allow for “expanding the number of nurses and allied health services available in general practices”. Again, the message seems to be that multidisciplinary, team-based or coordinated care (all good things) is only achievable through allied health practitioners working to or within a medical general practice.
The large majority of allied health practitioners who work in primary health care do not provide services through a GP practice. Most are independent practitioners and MBS subsidised services, referred by a GP, do not necessarily make up a substantial portion of their work.
The government is keen to support medical General Practice. However, to date there has been very little public discussion or testing of how proposed arrangements would work – certainly not against the reality of primary health care service provision as it exists, or how such an approach would enable better, more coordinated care for people (noting it certainly could and should) while managing the risks to existing allied health service capacity and access – especially in rural and remote Australia. These are fundamental design and funding issue, not minor implementation details.

National Preventive Health Strategy 2021–30: burden of disease targets – which (like the Strategy itself) aims to address the wider determinants of health, promote health equity and decrease the overall burden of disease. The report includes data used to monitor 3 of the 6 burden of disease specific targets in the Strategy.

the proportion of the first 25 years lived in full health will increase by at least 2 percentage points by 2030
the proportion of the first 0–4 years of life lived in full health will increase by at least 3.5 percentage points by 2030
Australians have at least an additional 2 years of life lived in full health by 2030.
Estimates for the remaining 3 indicators involve analysis at subnational level, which was not in the scope of the current report. These targets are:
- Australians in the 2 lowest socioeconomic groups will have at least an additional 3 years of life lived in full health by 2030
- Australians in regional and remote areas will have at least an additional 3 years of life lived in full health by 2030
- Aboriginal and Torres Strait Islander people will have at least an additional 3 years of life lived in full health by 2030.

Use of chronic disease management and allied health Medicare services – which we hope to examine in detail but note one Figure from the report (while not portraying the underlying problem of lack of MBS support for allied health care) shows rural and remote disadvantaged. Given the older age profile and higher rates of chronic disease among the rural population, subsidised access to AHP services should be higher generally but for other factors – like the lack of workforce supply.

AIHW: Australia's Disability Strategy - a new website that reports on the Outcomes framework of Australia's Disability Strategy 2021-2031 (the Strategy). It reports available data for priorities that people with disability have said need to improve if Australia is to be more inclusive.

Better Access – the evaluation report - the final report of an independent evaluation of the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative (Better Access), undertaken by the University of Melbourne. (Note – Better Access also included eligible OTs and Social Workers). The media release from Minister Butler anticipated much of the criticism that has since come out against the decision. In a press conference on the issue the Minister said “The evaluation finds that the location of provider services - so where particularly psychology clinics set up their operations - contributes to poor access by Australians living and living in rural areas, and also lower socioeconomic areas in our major cities. …. The evaluation found that all of the additional services went to existing patients, and that the number of new patients who are able to get into the system and get access to psychology service actually declined
by 7% over the course of that period. It also found that all of the growth - all of the growth – in services went to the highest income Australians, with the lowest income Australians actually receiving fewer services over this period than they had before the introduction of the additional 10.”

Unregistered NDIS providers - Thank you to SARRAH 2020 Squawk Award winner, Dr Kim Bulkeley, for sending through the report Unregistered NDIS providers are in the firing line – but lots of participants have good reasons for using them (theconversation.com) – which is covered in this week’s CEO update.

The WA Government announced over $2.5M to help disability service providers with workforce attraction and retention: extended to 13 disability service providers across Western Australia to help address workforce challenges in the sector. Initiatives funded include:

attracting allied health therapists looking to transition from the aged care sector and enhance their skill levels to work in the disability sector; (what does this say about allied health in aged care under the Commonwealth reform agenda?)
supporting disability support workers in achieving a formal qualification through the Recognition of Prior Learning process; and
growing the employment of Aboriginal disability support workers through skills training and workplace mentoring to provide culturally appropriate disability support services.

More information on the Fund can be found here.

The Commonwealth government announced a National Centre to explore innovative community-led solutions to address disadvantage
The Albanese Labor Government will establish a National Centre for Place-Based Collaboration (Nexus Centre) to explore and enhance community-led solutions in addressing social complex problems and entrenched disadvantage. The Centre is to consult extensively with stakeholders and designing community supports. The media release said “ Place-based solutions have an evidence base in generating positive outcomes in addressing complex social needs and entrenched disadvantage because the solutions are community-designed and led. The National Centre is envisaged to be an independent, non-government entity that will work with governments, communities and other stakeholders to amplify the benefits of place-based initiatives.”
The Nexus Centre is intended to support existing and emerging place-based initiatives around Australia, with a focus on Commonwealth programs and initiatives first, and a plan for scaling up its support over time. A core feature is meant to be shared commitment to a local strategy by communities, governments, service providers and investors, with shared accountability for planning, decision making and results. Watch this space.

Rural Workforce Agency Victoria (RWAV) released its 2021-22 Annual Report

According to the RWAV Workforce Needs Analysis, Physiotherapists, Speech Pathologists, Occupational Therapists and Psychologists (grouped with Psychiatrists) were identified as being among the top five the health professions in demand – after GPs. The report includes this informative piece (page 12):

OTHER NEWS

New Skills and VET arrangements ….again: On Tuesday 13 December, Minister for Skills and Training, the Hon Brendan O’Connor MP gave a speech to the CEDA where he announced there will be 10 new Jobs and Skills Councils to replace the Industry Clusters. The media release is here. Further information is available on the department’s website.

Reconciliation Australia has announced the theme for Reconciliation Week 2023 – 27 May though 3 June. The theme is Be a Voice for Generations – which aims to encourages all Australians to be a voice for reconciliation in tangible ways in our everyday lives – where we live, work and socialise. For more information – go here. s

Reminder – Allied health professionals recently gained access to the Commonwealth’s Free Interpreting Service – for more details go to this link.

Climate change and Australia’s rural health – lessons from Africa – an article.

Ian Yates (previous head of COTA) has been appointed Interim Inspector General of Aged Care - see the media release here.

Seeking your input:
SARRAH advocates strongly for the interests of rural and remote allied health and for these to be a fundamental consideration in national health and related service strategy design, oversight and development of integrated policy, program and service design. The value of allied health in addressing service gaps, demographic and population health trends needs to be better understood by decision-makers and funders.
To this end, SARRAH puts considerable effort into providing submissions to government and other inquiries and consultation processes. Those submissions are always better, and potentially more influential, when they are informed by the expertise and knowledge of our members. We encourage you contribute. A short email or a quick phone conversation on a subject of direct concern to you can be extremely valuable in these processes. If you’d like to contribute, please contact allan@sarrah.org.au.

The list of submissions we contributed to during 2021-22 can be found on page 20 of the SARRAH 2021-22 Annual Report.

CONSULTATIONS - NEW

Health profession National Boards and Ahpra are reviewing the current accreditation arrangements for the national health practitioner regulatory scheme to prepare for the next period to mid-2029. The current accreditation arrangements end on 30 June 2024 for all professions except paramedicine, which end on 30 November 2023. The National Boards and Ahpra intend to complete this scheduled review by May 2023. The last review was in 2018. The review aims to confirm performance and progress on current accreditation priorities and will inform the priorities for the next period, including how progress in priority areas could be measured. You can find the consultation paper here. Feedback is invited from all practitioners, stakeholders and the community. Feedback is also sought on specific questions about the accreditation arrangements including on performance and progress since mid-2019, and possible areas of focus for the next five-years, including how progress in these areas could be measured – and can be provided in two ways by close of business on 14 February 2023: through the response template (online) or a written submission by email, to accreditationreview@ahpra.gov.au.

Inquiry into the operation of the National Redress Scheme - The Joint Standing Committee on the Implementation of the National Redress Scheme has commenced a new inquiry into the operation of the Scheme. The Committee invites your views on any or all of the attached terms of reference. Key themes include:

The experience of First Nations applicants and applicants with disability in their dealings with the Scheme.
Accessibility, performance and effectiveness of support services and legal advice for survivors and their advocates.

The Committee is encouraging us to share this invitation with anyone who may have an interest in the inquiry.
Submissions close on Monday 27 February 2023. You can email your submission to us at redress@aph.gov.au. Click here for more information on how to make a submission. You can also contact the Secretariat on (02) 6277 4549.More information can be found at: www.aph.gov.au/redress.

CLOSING TODAY

The Joint Standing Committee (JSC) on the National Disability Insurance Scheme (NDIS)
Inquiry into the Capability and Culture of the National Disability Insurance Agency (NDIA) - Submissions closing 16 December 2022.

Cancer Australia is inviting your feedback on the public consultation for the Australian Cancer Plan (ACP), which sets a 10-year plan to improve outcomes. Cancer Australia is calling for coordinated system-wide engagement and inviting comment on a on the strategy, priority areas, objectives and actions in cancer control. To view the draft Australian Cancer Plan and provide feedback, visit engage.australiancancerplan.gov.au. Public consultation will close on 16 December 2022.

CLOSING SOON

The Commonwealth Government review of the Disability Services Act. The Act governs how the Government provides services for people with disability to improve their independence and participate in community and economic life. The new Act will also provide a basis for continued supports and services outside the NDIS for people living with disability, and support priorities in Australia’s Disability Strategy 2021-31, the national disability policy framework. (See the separate submission process on the Strategy, below).
Consultation on the Disability Services Act is open until 20 December 2022. More details are available at DSS Engage.

Review of the NDIS. You are invited to “Have your say” online by 5 pm Saturday 31 December 2022. A supporting paper is available at Our Approach. There is also a summary version and an Easy Read version (PDF 1 MB). The Review team also indicate you can “contact us” if you need more time.

The ACSQHC is updating the National Consensus Statement: Essential elements for safe and high-quality end-of-life care. The Consensus Statement sets out suggested practices when providing end-of-life care in all relevant healthcare settings. You can view the revised version here. Importantly, the updated Consensus Statement broadens the scope beyond hospitals, to include Primary and Community Health Care and residential aged care settings. The Commission would like your feedback on the draft Statement through a short online survey which is open until 14 January 2023.

The National Dementia Action Plan is a joint initiative of the Australian Government and state and territory governments. It is a 10 year plan to put people living with dementia, their families, and carers at the centre of all action on dementia.
The consultation paper is available in several formats - summary of the consultation paper (15 pages); consultation paper on a page; and consultation paper (70 pages). You can provide feedback by completing an online survey (approx 15 mins) or by emailing dementiaplan@health.gov.au. The consultation closes on 23 January 2023. This information is also on the Department of Health and Aged Care’s consultation hub.

The Federal Government has opened the 2023-24 Pre-Budget Submissions process. This is the opportunity for individuals, businesses and community groups on their views regarding priorities for the 2023-24 Budget. Submissions are due by Friday 27 January 2023.

SARRAH will be advocating for investment in much needed allied health workforce and service support in rural and remote Australia to address chronic systemic shortfalls. We’ll also push for our service systems to better reflect the realities and needs of rural and remote communities.
SARRAH strongly urges members and friends to contribute to the process, either directly and/or through SARRAH.

The Australian Commission on Safety and Quality in Healthcare (ACSQHC) has developed a draft Sustainable Healthcare Module to add to the National Safety and Quality Health Service (NSQHS) standards - recognising the importance of sustainable, adaptable and resilient healthcare services. ACSQHC are inviting you to help shape the future of Australia's sustainable healthcare. The draft Module was developed by healthcare and environmental experts and contains five actions, including sustainability measures and targets. You can access the Module for consultation here. The consultation will close on 31 January 2023.

CONSULTATION REMINDERS

The National Mental Health Commission is developing a National Stigma and Discrimination Reduction Strategy to address mental health-related stigma and discrimination. The Draft Strategy is available for input and feedback, with input due by 1 February 2023. The Commissioner invites you to provide your feedback via an online survey on proposed actions and/or by uploading a submission.
If you have questions, please reach out via email to StigmaStrategy@mentalhealthcommission.gov.au.

The Senate Community Affairs References Committee is inquiring into the extent and nature of poverty in Australia, with a report due by 31 October 2023. The Terms of Reference include – to quote: (c) the impact of poverty on individuals in relation to: (i) employment outcomes, (ii) housing security, (iii) health outcomes, and (iv) education outcomes. Further detail about the scope of the inquiry is provided in the terms of reference. Submissions are sought by 3 February 2023.

The Australian Parliament’s House Standing Committee on Employment, Education and Training is commencing an inquiry into the perceptions and status of vocational education and training.
More information about the inquiry is available here, including the terms of reference. Submissions are due by Wednesday 1 March 2023

The Joint Standing Committee (JSC) on the National Disability Insurance Scheme (NDIS)
Submissions close on 30 June 2023 Inquiry into and report on general issues around the implementation, performance, governance, administration and expenditure of the NDIS

The Australian Bureau of Statistics has commenced a comprehensive review of ANZSCO to reflect the contemporary Australian labour market and better meet stakeholders’ needs. SARRAH has flagged this previously. Further information on how to participate in the upcoming consultations is now available. Resources for the ANZSCO are available at Updating ANZSCO. Contact anzsco.maintenance@abs.gov.au if you would like to subscribe to receive communication on the ANZSCO update.

Independent Review of Health Practitioner Regulatory settings - Minister for Finance Katy Gallagher and Minister for Health and Aged Care Mark Butler announced the review of regulatory settings relating to health practitioner registration and qualification recognition for overseas trained health professionals and international students who have studied in Australia. The Review, announced by National Cabinet on 30 September 2022, will deliver recommendations designed to ease skills shortages in key health professions - including nursing and midwifery, medicine, psychology, pharmacy, para-medicine and occupational therapy.

SARRAH anticipates the review, which will be led by Robyn Kruk AO (former-Director General of NSW Health), will involve a consultation process. We’ll keep you updated.

SUBMISSIONS
SARRAH has recently provided submissions to the following consultation processes:

the Joint Select Committee on Northern Australia inquiry into Northern Australia's workforce development.

The ADEA NDSS Aboriginal and Torres Strait Islander Health Worker and Health Practitioner Mentoring Program exists to encourage a mutually beneficial relationship between a CDE mentor and an Aboriginal or Torres Strait Islander Health Worker or Health Practitioner mentee.

Indigenous Psychological Services: 2023 workshops with Dr Tracy Westerman AM are now available: spots are limited.

The Department of Health and Aged Care is working with the Wicking Dementia Research and Education Centre at the University of Tasmania to develop introductory and refresher learning packages for aged care workers. These are also available for anyone with an interest in caring for older people. The first 6 modules are now available for free online. All modules are expected to be available by March 2023.
The modules are approximately 10 minutes long and cover a range of topics including:

dementia and palliative care
trauma-informed care
wound management
cross-cultural awareness
oral health
mental health and wellbeing
falls management.

Each module is accompanied by interactive learning materials and links to further learning opportunities to enable ongoing group or individual on-demand learning.
Register and enrol for these modules at Equip Aged Care Learning (utas.edu.au).
For further enquiries, email equip.learning@utas.edu.au

Natural Disaster Recovery Support
On Rural Health Pro, you can find an overview of key recovery grants and assistance available to support the rural health workforce and relieve some of the costs of rebuilding practices.
To access 24/7 mental health and wellbeing support, please call:

Lifeline – 13 11 14
Beyond Blue – 1300 224 636
NSW Mental Health Line – 1800 011 511.

External Grant Opportunities
AUS: FRRR Strengthening Rural Communities (SRC) - Rebuilding Regional Communities Large Grants
AUS: MRFF 2022 Clinical Trials Activity Grant Opportunity
AUS: Disabled Children's Foundation General Grants
AUS: Stillbirth and Miscarriage Support Grant Funding
AUS: Improving respite care for people with dementia and their carers grant funding
AUS: Obama Foundation Scholars Program
AUS: National NAIDOC Awards Nominations
AUS: Improving respite care for people with dementia and their carers
AUS: Ferris Family Fellowships
AUS: MRFF - Million Minds Mental Health Research Mission - 2022 Mental Health Research Grant Opportunity
WA: Healthy Research Program - Exploratory Research Grants
QLD: Queensland Reconciliation Awards
NSW: Cancer Screening and Prevention and Cancer Control Grants Program
NSW: FRRR: The Yulgilbar Foundation Fund
VIC: FRRR Community Grants Program

Change to DVA’s Nutritional Supplementation request form for veterans residing in a residential aged care facility

June 7 - 9, 2023, Gold Coast, Qld, Australia

Rural health professionals and students can register now to attend the RWAV Conference at the Rydges in Geelong on Thursday, 16th February 2023.

New guiding principles for medication management

Guiding principles for medication management in residential aged care facilities
Guiding principles for medication management in the community
Guiding principles to achieve continuity in medication management

RACGP HAS just launched the new Infection prevention and control guidelines for general practices and other office-based and community-based practices (the IPC Guidelines) on our website.
The IPC Guidelines provide you with updated guidance on planning and implementing high standards of infection prevention and control in your workplace by addressing:

the basics of infection prevention and control (including principles, hand hygiene, personal protective equipment, aseptic technique, levels of precaution)
managing risks to staff (including staff screening immunisation and infection management, sharps, exposure to blood and other body substances)
managing the practice environment (including cleaning, laundry and waste management)
managing equipment (including reprocessing reusable medical devices)
managing outbreaks (including disease surveillance and outbreak response)
practice setup (including practice design, fit-out, equipment and consumables).

Complete Advertising Listing Form and submit it to sarrah@sarrah.org.au .

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Level 2, 53 Blackall Street, Barton, ACT, 2600

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Phone: 1800 338 061
Email: sarrah@sarrah.org.au

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